A Case of Primary Aspergillus Empyema



A diverse spectrum of clinical diseases have been ascribed to Aspergillus species. We present a patient with primary Aspergillus empyema who responded favorably to percutancous needle drainage and a prolonged course of antifungal therapy. A 75 year old man with paroxysmal nocturnal hemoglobinuria received pulse dexamethasone therapy (20 mg Q3 weeks) for 3 years. He presented with fever cough, and dyspnea of 6 months duration. Chest CT revealed a loculated pleural effusion in the right lung base and needle drainage was performed. Pleural fluid cultures grew A. fumigatus. He was treated with amphotericin B for 10 weeks (total 2.4 g) followed by oral itraconazole solution for 12 weeks. He has had clinical and radiographic resolution of disease and has resumed his previous lifestyle. This patient represents the first well described case of primary empyema due to Aspergillus. Literature review suggests that secondary Aspergillus empyema occurs more commonly. Predisposing conditions for secondary Aspergillus empyema are bronchopleural fistulae, aspergilloma with cavity rupture, or Aspergillus pneumonia. We may observe that as immunosuppressive therapy is used more widely, uncommon manifestations of fungal diseases, such as primary Aspergillus empyema, may emerge.

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36th Annual Meeting of the Infectious Diseases Society of America
    • IDSA 36th